Are younger patients considered?: Geographic access and age-focused design in advanced PDAC trials for Appalachian populations.

e16384 Background: Younger-onset pancreatic ductal adenocarcinoma (PDAC) represents a clinically distinct population with rising incidence. Geographic and socioeconomic barriers limit trial access for young patients, while Appalachian regions experience disparities in cancer care access and outcomes. We evaluated age-focused trial design and access to interventional PDAC trials in Appalachian and socioeconomically deprived counties. Methods: Clinical trial data were obtained from ClinicalTrials.gov and restricted to interventional studies enrolling patients with advanced or metastatic PDAC. Trials were systematically and manually selected to include studies with at least one U.S. site and an overall status of Recruiting or Active, not recruiting. The final cohort of 275 trials was screened for age-focused design, including age-stratified cohorts or planned age-based subgroup analyses for adult PDAC patients under age 50. Appalachian status was evaluated at state and county levels using Appalachian Regional Commission (ARC) designations. County-level trial access was assessed via a trial desert framework (no eligible trial site within 50 miles). Socioeconomic deprivation was measured using the Area Deprivation Index (ADI) and rurality using Rural–Urban Continuum Codes (RUCC). Associations with trial desert status were evaluated using logistic regression. ChatGPT 5.2 (1/26/26) was used for code-writing assistance and troubleshooting R software. All statistical analyses were performed via R. Results: Among 275 interventional trials enrolling patients with advanced PDAC, none (0%) were designed to distinctly target younger-onset PDAC. Although trials permitted enrollment across broad adult age ranges, no trials incorporated age-focused design distinguishing younger patients. While 180 trials (65.5%) included at least one site in an Appalachian state, only 51 trials (18.5%) included a site in an ARC-designated Appalachian county. Trial sites were concentrated in metropolitan areas, and none met rural criteria (RUCC ≥5). Higher county-level socioeconomic deprivation was strongly associated with trial desert status. A 10-point increase in ADI increased the odds of being classified as a trial desert by 35% using a 50-mile definition (OR 1.35; p < 2×10⁻¹⁶), with similar findings at 100 miles (OR 1.28; p = 7.9×10⁻⁸). Associations persisted after accounting for rurality and did not differ by Appalachian designation. Conclusions: Interventional trials for advanced or metastatic PDAC lack age-focused design for young patients. Though state-level definitions suggest broad Appalachian representation, county-level ARC analysis shows that fewer than one in five trials include Appalachian sites. Younger PDAC patients, especially those in deprived or Appalachian regions, may be underserved by both trial design and trial geography.